基于倾向性评分匹配的ERAS在原发性肝癌肝切除围手术期的应用

Application of enhanced recovery after surgery in perioperative period of hepatectomy for primary liver cancer:A propensity score matching based analysis

目的 探讨加速康复外科(ERAS)在原发性肝癌(PLC)肝切除围手术期应用中的安全性及有效性。方法 回顾性分析2014年1月至2018年9月在南华大学附属第一医院肝胆胰外科因PLC行肝切除手术的109例患者临床资料。根据围术期管理方法不同分为ERAS组(n=56)和传统组(n=53),然后基于倾向性评分匹配(PSM)法比较两组患者术中情况及术后恢复情况。结果 两组患者的基线资料经PSM后平衡良好,每组患者均为40例。两组在基线一般资料、手术时间、术中出血量及输血率方面比较,均无统计学差异(P>0.05)。与传统组相比,ERAS组术后第1、4、7天WBC更低,但ALB水平更高(P<0.05)。ERAS组患者术后进食更早[(2.03±0.36)d vs (4.33±2.12)d,P<0.05],下床活动时间更早[(50.38±24.76)h vs(79.05±40.73)h,P<0.05],肛门首次排气时间更早[(2.63±1.12)d vs (3.28±0.88)d,P<0.05],腹腔引流管拔除时间更早[(5.03±0.36)d vs (9.05±3.69)d,P<0.05],且术后住院时间缩短[(13.48±4.95)d vs(16.00±5.52)d,P<0.05],住院总费用降低[(4.15±0.49)万元vs (5.39±1.74)万元,P<0.05],术后中重度疼痛发生率更低(30.0%vs 60.0%,P<0.05)。结论 ERAS应用于PLC肝切除围手术期是安全有效的。

Objective To investigate the safety and efficiency of enhanced recovery after surgery(ERAS)in the perioperative period of hepatectomy for primary liver cancer(PLC).Methods The clinical data of 109 patients who underwent hepatectomy due to PLC between Jan.2014 and Sep.2018 in the First Affiliated Hospital of University of South China,were retrospectively reviewed.According to perioperative management methods,patients were divided into ERAS group(n=56)and conventional group(n=53).And then,based on propensity score matching(PSM),patients were re-grouped,the intraoperative and postoperative recovery between the two groups were compared.Results After PSM,the baseline data in the two groups were well balanced and 40 patients in each group.In terms of baseline general information,operation time,intraoperative bleeding volume and blood transfusion rate,there was no statistical difference between the two groups(P>0.05).Compared with the conventional group,levels of serum WBC in ERAS group were significantly lower on 1st,4th,and 7th day postoperative(P<0.05),and ALB levels were significantly higher on 1st,4th,and 7th day postoperative(P<0.05).Patients in the ERAS group started eating earlier[(2.03±0.36)d vs(4.33±2.12)d,P<0.05]and got out of bed earlier[(50.38±24.76)h vs(79.05±40.76)h,P<0.05],the first time of anal exhaust was earlier[(2.63±1.12)d vs(3.28±0.88)d,P<0.05]and the time of abdominal drainage tube removal was earlier[(5.03±0.36)d vs(9.05±3.69)d,P<0.05].For ERAS group,the postoperative hospitalization time was shorter[(13.48±4.95)d vs(16.00±5.52)d,P<0.05],the total expense on hospitalization was lower[(41500±4900)yuan vs(53900±17400)yuan,P<0.05],and the postoperative incidence of moderate to severe pain was lower(30.0%vs 60.0%,P<0.05).Conclusion ERAS is safe and effective in perioperative period of hepatectomy for PLC.